Background At Severn Hospice, oral methadone is used as an adjunct to opioid analgesia to manage complex pain. This includes neuropathic or mixed nociceptive cancer related pain. Patients are assessed carefully prior to treatment and suitable candidates are admitted to the hospice. Methadone is introduced at a low dose. As the methadone is increased, the existing opioid is reduced by 20%. Opioids are never discontinued.

The aim of the audit was to look at the safety and efficacy of this method of pain control and to review our internal guideline.

Method The audit was conducted for a period of 12-month (1/8/19 to 31/7/20). 11 patients were identified.

Results The maximum dose of methadone used was 20 mg BD. Most patients were on methadone and opioids between 3 to 10 months to control their symptoms, during this audit period.

None of the patients had major side effects. Methadone was never withdrawn due to side effects and no patients had toxicity during titration.

Conclusions Methadone is a good adjuvant analgesia and safe to use with opioids. It is a cheap drug. There were no major side effects seen, including no cardiac symptoms.

Based on this audit, routine ECG may not be required on initiation and may be safe to be started in clinics.